Claim Form - St.louis County, Missouri
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1INSTRUCTIONS FOR FILING CLAIMS AGAINST AN ESTATE
Information on making claims against an estate can be found in Section 473.360 RSMo for decedent’s estates
and Section 475.205 RSMo for conservatorship estates. ALL CLAIMS AGAINST AN ESTATE MUST BE
FILED IN DUPLICATE.
IN THE PROBATE DIVISION, CIRCUIT COURT, ST. LOUIS COUNTY, MISSOURI
In the Matter of
____________________________________________________________
No. ______________
Deceased, Disabled, Minor
CLAIM
Claimant, _________________________________, which is a (corporation) (partnership) (individual) and
(type or print name)
states that there is due claimant from this estate the sum of $ _______________________ based
upon
the
ATTACHED ITEMIZED STATEMENT. Claimant holds security as follows (if none, so state; otherwise
describe):
The undersigned states (he) (she) is the (claimant) (agent) (attorney) (officer) for claimant and has to the best
of undersigned’s knowledge and belief, given credit to all payments on and offsets against the amount claimed,
the balance claimed is justly due, the allegations herein are made under oath or affirmation, and the
representations are true and correct to the best of undersigned’s knowledge and belief subject to the penalties of
making a false affidavit or declaration.
Date: _________________________
____________________________________________________________
Signature of Claimant or Person Signing for Claimant
____________________________________________________________
Name of Claimant or Person Signing for Claimant (printed or typed)
____________________________________________________________
Title of Person Signing for Claimant (printed or typed)
Address of Claimant:
______________________________________________________________________
No. and Street
City
State
Zip Code
Attorney for Claimant: ______________________________________________________________________
Name
Address
WAIVER OF SERVICE OF NOTICE OF CLAIM;
CONSENT TO ALLOWANCE
(Strike any portion not applicable)
Undersigned waives service of notice of the above claim and consents to its allowance in the amount of
$_______________________________.
Date: _________________________
__________________________________________
__________________________________________
Signature of Attorney for Personal
Signature of Personal Representative
Representative or Conservator
or Conservator
For Court’s Use Only:
0 KCAE – Claim Against the Estate
Probate Claim
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